Prenatal and preconception subjective distress from the 2016 Fort McMurray wildfire in Canada: Comparison to other disasters

摘要

Background: In May 2016, the wildfires around Fort McMurray (FMM), Alberta, Canada forced the evacuation of 88,000 people, including ~ 1,250 pregnant women and 600 more within a few months of conception. Our other natural disaster studies (1998 Quebec Ice Storm, 2008 Iowa Flood, 2011 Queensland Flood) document that prenatal or preconception maternal exposure to natural disasters can result in high levels of maternal objective hardship, subjective distress, and negative cognitive appraisals of the disaster; these can have negative effects on pregnancy outcomes and predict adverse developmental trajectories for the newborn, especially neuro-developmental and metabolic. The 2016 FMM wildfire presents a new opportunity to replicate previous disaster studies, and to test a brief, online intervention. Our overall study goals are threefold: (i) determine whether an expressive writing intervention supports maternal resilience, and test its ability to buffer women and their babies from the effects of disaster-related stress; (ii) develop a new allostatic load index of modifiable maternal stress 'omics markers for predicting risk and responsiveness to the intervention; and (iii) integrate knowledge engagement so that the processes and outcomes of research are beneficial to community and stakeholders. For this abstract, our goal was to compare the level of subjective distress experienced by the FMM cohort with those observed in other disaster cohorts. Methods: Subjects are women who were pregnant during the fire, or who conceived since the fire. Recruitment commenced in November 2016 and is on-going, with approximately 200 women recruited by May 2017. Quantitative and qualitative data are collected via a secure online platform. Maternal subjective distress is measured at recruitment using the Impact of Event Scale - Revised to assess post-traumatic stress disorder (PTSD) symptoms, the Peritraumatic Distress Inventory, and the Peritraumatic Dissociative Experiences Questionnaire . Results: Preliminary results find significantly higher maternal subjective stress relative to our other natural disaster cohorts. Nearly 40% of FMM women reported clinically significant levels of peritraumatic distress, with 42% reporting significant dissociative experiences, at the time of the crisis; these levels are 6.9 and 3.3 times higher, respectively, than those observed in our Queensland Flood cohort, and 10.7 and 5.6 times higher than in our Iowa Flood cohort. PTSD symptoms were also significantly higher in our FMM cohort with 26.4% of women screening positive for PTSD, a rate that is 3 times higher than observed in our Project Ice Storm and 7.5 times higher than observed in the flood cohorts. PTSD rates in FMM were 3.9 percentage points lower than those published following Hurricane Katrina (30.3%), and 10.4 points lower than following the 2010 Haitian earthquake (36.8%). We will report final cohort results at the meeting. Conclusions: Given the extreme stress, this research will improve understanding of the impact of prenatal stress on maternal and fetal outcomes. Preliminary results suggest that this is the ideal cohort on which to determine the effectiveness of a simple intervention in supporting maternal and fetal resilience. The findings of this study have the potential to inform decision-making and support use of a simple intervention following disasters.